Paul Wyatt, Medicare Insurance Broker

Answer: Absolutely! Many plans and call centers use tricky wording and benefits to entice people but they do not give full transparency on the particular plan they are marketing or the qualifications to enroll into them. These companies/call centers make the agents job more difficult every day by switching individuals over the phone into plans that have none of their doctors in network by promising them a food card or specific benefit that they may not even qualify for.

Answer: Part B is your health insurance or for layman's terms your doctor coverage. However, Medicare is only 80/20 insurance which means you are responsible for the 20% that isn't covered. To cover the gap you will need to choose 1 of 2 paths. Those paths are either a medigap plan with a Part D drug plan or a Medicare Advantage plan. No one should ever rely on just Original Medicare as the 20% gap can be very costly and devastating especially if a major health event occurs.

Answer: Medicare does not pay for your groceries. However, many Medicare Advantage plans do offer grocery cards that can be used at several retailers. These plans do carry qualifications to be able to enroll into them though.

Answer: Depending on the medication that may be a very tricky answer. With some medications that do not have a generic version available you may find a plan that covers it but the copay potentially may be very high. The positive note however, is with the Inflation Reduction Act the Part D out of pocket max is set at $2,100 for 2026 so you can not pay for than that for all of your medications for the year. If you reach the cap then you fall into what is called catastrophic coverage and meds will be covered at $0 copay till the end of the year.

Answer: No, if you are already enrolled into Medicare then you do not have to re-sign up. However, depending on your plan selections and the state you reside in you may have new options available to you now that you're turning 65.

Answer: Annual Enrollment is the most important time of the year for Medicare enrollees. This is the time you will want to review your Part D or Medicare Advantage plan for the coming year as this will be the only open enrollment time of the year for both products without qualifying for a Special Enrollment Period. Some of the changes you will see from year to year are premium increases, drug formulary changes, plan area reductions, plan eliminations, doctor network changes, copay increases, etc. There are many changes that you want to review just to be sure that the plan you are on will be the best option for next year. You don't want to be on a plan that has a drastic increase in price or decrease in coverage when a similar plan can be found for a better price or more benefits.

Answer: Each plan has a different way that their particular cards can be used. Some carriers can be used in chain stores and others you must use mail order for the products they offer. For many of them though you can use the OTC network app and load your plan in and it will show you the amount you have to spend as well as the products you can purchase.

Answer: With Part C plans the daily copay can vary for hospitalization. For your particular scenario though, if you are hospitalized then you will have a daily co-pay of $350 for the first 7 days. Once you are passed 7 days then you will be covered at $0 from days 8-90. For instance if you are hospitalized for 3 days then you would have a co-pay of $1,050. On the flip side of that, if you are on Original Medicare then you will owe the $1,676 deductible upon being admitted to the hospital no matter the amount of days you are there. For the same same scenario of being admitted for 3 days that we used prior you would owe the full Part A deductible of $1,676.

Answer: That all depends on what you have currently. A few steps to take would be to make sure your Part A & B are turned on or set to be turned on once you retire. Also make sure you have chosen your secondary insurance path to cover the 20% that Medicare does not cover. That can be either a Medigap plan with a Part D or a Medicare Advantage plan.

Answer: I would recommend calling 1-800-Medicare and report your findings. Depending on the specific nature they will be able to further guide you on the proper steps to take.

Answer: Plans are very much zip code based especially if you are referring to a Medicare Advantage plan. They can have drastically different copay amounts and ancillary benefits even if you have the same plan name/code because they are set geographically based on data in the selected area. Hence the importance of shopping a plan for your area because what works in one area may not work in another.

Answer: It's absolutely ok because you want to have someone you trust will look out for your best interests. I wouldn't go to overboard with it because they should all be able to offer most of the products and plans available in your area. If you're unsure who to use I would recommend narrowing it down to 2 or 3 agents in your area and calling to schedule a short meeting just to get to know them and what plans they offer. I would also be straight forward and letting them know you are not going to make a decision today on plans just so you are both on the same page and not wasting anyone's time.

Answer: The simple answer is 20% of the total charge after you have met your Part B deductible of $257 because Medicare is 80/20 insurance. The complicated answer is that each hospital/organization will charge different amounts based on the care you require in an emergency situation. I would never recommend staying on just Original Medicare because the 20% responsibility is uncapped and leaves a lot of personal financial exposure.

Answer: The best advice is to shop your plan once Annual Enrollment begins on October 15th. If you don't have an agent to assist you then I do recommend finding one in your area because they will usually have the best knowledge for specific situations such as that.

Answer: Many agents and organizations sponsor Medicare education events all year round. A Medicare 101 is a great way to learn about the basics of Medicare and what factors you should consider when choosing a plan.

Answer: If you still have employer coverage then you do not necessarily need Part B. However, it is best to sit down and compare your current plan to Medicare and see which would give you the best deal. Factors to consider in the comparison are premium, deductible, and max out of pocket. Once these figures are taken into account then you can make an educated decision on whether to continue employer coverage or to go fully onto Medicare.

Answer: It all comes down to the level of comfortability you have. Many people prefer having a local agent they can speak to and see for all of their questions and concerns about Medicare. Also, that agent will more than likely reach out to you yearly with any plan updates or changes for the next plan year. Not that there is anything wrong with a virtual agent but many times they may not know the local area and how plans work near you with the local physicians and pharmacies. This can be especially true when it comes to Medicare Advantage plans. When it comes to agents in general I would recommend finding a broker, no matter if that is a local or virtual agent, to assist you because they will be able to compare plans across multiple carriers. When you contact a specific carrier they will only be able to compare the specific plans they offer and you may miss out on a better plan.

Answer: Many times the plan is not explained to them and they do not fully understand what they are agreeing to. When the presence of so many call centers and aggressive marketing techniques it seems many feel duped into a plan they can't fully use. I always recommend finding a local agent that you can trust and speak to when discussing your options. There is no perfect answer when it comes to choosing a Medicare plan because everyone is different and has varying health needs. Advantage plans can be a great option but they are not for everyone and not every plan is created equally. If this is an option you are considering then I would recommend sitting down with an experienced individual to discuss if it is the right option for you.

Answer: Absolutely! Medicare A&B covers preventative services like the shingles vaccine as well as many others like flu, pneumonia, covid-19, and many others.

Answer: The best way to find out is by contacting your local social security office and asking if you fall into the IRMAA bracket. IRMAA is an additional surcharge added to your Part B and D premiums if your income exceeds the government set thresholds. According to the limitations it classifies you as a high income earner in retirement. The brackets are based on your adjusted gross income from the previous 2 years. For 2026 IRMAA, your 2024 tax return is used. There is a chart available with the income brackets linked to each surcharge you may receive. You can access this chart by contacting the social security office or by searching IRMAA bracket online.

Answer: You should be shopping your drug plan every year during Annual enrollment by comparing all plans available in your area. Also, many plans have better copays associated with different pharmacies. Many times it helps to compare different pharmacies available to you as well as shopping your plan.

Answer: Figure out what is most important to YOU when it comes to your health plan. There are a lot of factors to consider when looking at your options but the most important thing at the end of the day is you.

Answer: If they miss an enrollment window and do not have qualifying creditable coverage as good as Medicare then they will have a penalty imposed upon them. For example, if an individual has started Original Medicare (A&B) but they decline Part D (prescription drug) and they have no other insurance then they will begin to accrue a penalty until they pick up a Part D drug plan. This penalty continues to accrue every month they go without coverage. Once they do pick up Part D then a penalty will be assessed for every month they went without and they will continue paying said penalty for their lifetime.

Answer: That is a very complicated question to answer. In order to explain or understand the difference more information is needed. Yes, plans are different based on zip codes but it would also be based on the type of plan they have as well.

Answer: Yes, they are covered under Part A and Part B. However, they will likely only be covered at 80% because Original Medicare is 80/20 insurance. You will typically pay coinsurance or a deductible when seeking these services with only Original Medicare.